Montana Medicaid History and Facts

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Initial Medicaid Implementation: Prior to the implementation of the Medicaid program, Montana had a program that helped low-income seniors under the Kerr-Mills legislation. The plan was not generous and paid approximately 19 cents for medical care for every beneficiary on the program. Montana began their Medicaid program in July of 1967. When the program began, the state decided not to cover the “medically indigent” or the medically necessary population.

Key Medicaid Political Issues: The state has had several expansions of coverage outside of the ACA’s Medicaid expansion. The state enhanced provider payments and extended long-term care coverage while making the application process easier for beneficiaries in 2011-2012. Montana’s other main Medicaid issues have focused on issues related to the rural nature of the state.

Medicaid Expansion Implementation: Montana had rejected several attempts to expand Medicaid in 2013 ad 2014. The Democratic governor, Steve Bullock had long supported Medicaid expansion and proposed several policies that would have expanded either through a waiver or through the traditional expansion. A 2013 plan had bipartisan support in the legislature but failed to pass. In 2014 there was a campaign to get Medicaid expansion on the ballot through referendum but failed to collect enough signatures. Montana expanded Medicaid effective January 1, 2016. The state included a waiver that was approved by CMS in November of 2015. The waiver requires beneficiaries to pay a premium that is 2% of their income and enrollees that fail to pay their premium are barred from reenrolling for three months. The state included a sunset date in the original legislation of 2019 and whether the sunsetting of the legislation should continue is under debate in the 2018 elections. In November 2018, Montana will vote on continuing the Medicaid expansion with a change to the proposed revenue source. The state will vote whether to fund Medicaid expansion through an increase to the state’s cigarette tax.

General facts about Montana Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Healthy Montana Kids (HMK) Plus

Separate or combined CHIP: Combination

Medicaid Enrollment: 279,000 (2018 estimate)

Total Medicaid Spending: $1.8 billion (FY 2017 estimates)

Share of total population covered by Medicaid: 22%

Share of Children covered by Medicaid: 44% (estimate)

Share of Medicaid that is Children and Adults: 71%

Share of Spending on Elderly and people with disabilities: 59%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 65.54%

Expansion state: Yes

Number of people in expansion: 58,000 (2018 estimate)

Work Requirement: No


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